Effect Of Permissive Hypercapnia On Cerebral Oxygen Metabolism In Robotic Assisted Radical Surgery For Elderly Patients With Bladder Cancer

ObjectiveTo observe the effect of permissive hypercapnia on cerebral oxygen metabolism in robotic assisted radical bladder cancer surgery,and to study the effect of permissive hypercapnia on such surgery.Subjects and Methods70 cases of patients with ASA II or?who were scheduled for robot-assisted radical surgery for bladder cancer were enrolled in this study.The patients aged between 65-82 years,including 57 males and 13 females were divided into two groups by random number table method.The two groups were mechanically ventilated after general anesthesia induction.Using a small tidal volume?VT=6-8ml/kg?combined with PEEP?5cmH₂O?ventilation parameters,adjust PaCO₂ at35-45mmHg;When the patient was adjusted to the Trendelenburg position,the respiratory rate and tidal volume were set to maintain the PaCO₂ in the N group at35-45 mmHg and the PHC group at 46-55 mmHg.Maintain BIS values between40-60 and nasopharyngeal temperature Near 36.5°C during surgery.Before induction?T₀?,5 min?T₁?after tracheal intubation,5 min?T₂?in T position,30 min?T₃?in T position,and 90 min?T₄?in T position MAP,HR,SpO₂,BIS were recorded,Blood samples were taken from radial artery and jugular bulb for blood gas analysis.Da-jO₂,CERO₂,Da-jGlu and Da-jLac were calculated.The volume,pneumoperitoneum time,T position time,awakening time and extubation time were recorded.ResultsSixty-eight patients completed the study and two were excluded.There was no significant difference in age,height,weight and preoperative hemoglobin concentration between the two groups?P>0.05?.There was no significant difference in bleeding volume,infusion volume,urine volume,pneumoperitoneum time and T position time between the two groups?P>0.05?.There was no significant difference in anesthesia time,recovery time and extubation time between the two groups?P>0.05?.Compared with T₀,the T₁ and T₄ HR were significantly lower in the two groups.Compared with T₁,the ETCO₂ in the PHC group was significantly higher at the T2-T4?P<0.05?.There were no significant differences in MAP,HR and BIS between the two groups?P>0.05?.Compared with T1,PaCO2 and SjvO2 were significantly increased in PHC group at T₂-T₄,CERO₂ and Da-jvO₂ were decreased,and JBP was significantly increased in T2-T4 between the two groups?P<0.05?.Compared with group N,PaCO2 and SjvO2 were significantly increased in PHC group at T₂-T₄,and CERO₂ and Da-jvO₂ were decreased?P<0.05?.There was no significant difference in Da-jGlu and Da-jLac between the two groups?P>0.05?.Conclusion1.Permissive hypercapnia can improve brain oxygen metabolism in robotic assisted radical surgery for elderly bladder cancer.2.Permissive hypercapnia is useful in elderly patients undergoing robot-assisted radical surgery for bladder cancer.